Provider Demographics
NPI:1447557186
Name:TRENT, SARAH B (PTA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:B
Last Name:TRENT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4260 NATURE TRAIL DR SE APT 2A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-3848
Mailing Address - Country:US
Mailing Address - Phone:616-307-2499
Mailing Address - Fax:
Practice Address - Street 1:4260 NATURE TRAIL DR SE APT 2A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-3848
Practice Address - Country:US
Practice Address - Phone:616-307-2499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502002062225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant